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April 12, 2010

Less Is More

Arch Intern Med. 2010;170(7):584. doi:10.1001/archinternmed.2010.48

Our current health care system operates on the unspoken but widely prevalent belief that more care is always better than less and that new technology is always better than older methods. Yet, there are many cases in which these assumptions are wrong. Clearly, these erroneous assumptions negatively affect health by exposing patients to unnecessary harms of treatment and testing, with no expected benefit; they also increase the total cost of health care.

To stimulate a conversation on this topic, the editors of the Archives are excited to launch a new feature: “Less Is More.” This feature will identify articles that document cases in which less health care results in better health and offer commentary on the specific implications. Some examples of this phenomenon from recent issues of the Archives include evidence that (1) the risk of developing cancer in association with unnecessary computed tomographic scans is substantial13; (2) there is a wide variation in the use of feeding tubes in nursing homes, with no demonstrable benefit of their use4; (3) there is unexplained variation in use of antipsychotic agents in nursing homes, many for patients without any indications for use5; and (4) there is evidence that elderly persons do the same or better with careful drug discontinuation.6 We also invite our readers to submit vignettes from actual patient encounters or clinical experiences that illustrate how less is more.

I am delighted to announce the appointment of Deborah Grady, MD, MPH, as Section Editor for “Less Is More.” Dr Grady is Professor of Medicine, Associate Dean for Clinical and Translational Research, and Co-Director of the Clinical and Translational Science Institute at the University of California, San Francisco. Readers will learn more about this section in our May 10th issue.

Correspondence: Dr Redberg, Archives of Internal Medicine, University of California, San Francisco, 505 Parnassus, Ste M-1180, San Francisco, CA 94143-0124 (redberg@medicine.ucsf.edu).

Financial Disclosure: None reported.

Berrington de González  AMahesh  MKim  K-P  et al.  Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 2009;169 (22) 2071- 2077
Smith-Bindman  RLipson  JMarcus  R  et al.  Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 2009;169 (22) 2078- 2086
Redberg  RF Cancer risks and radiation exposure from computed tomographic scans: how can we be sure that the benefits outweigh the risks? Arch Intern Med 2009;169 (22) 2049- 2050
Lopez  RPAmella  EJStrumpf  NETeno  JMMitchell  SL The influence of nursing home culture on the use of feeding tubes. Arch Intern Med 2010;170 (1) 83- 88
Chen  YBriesacher  BAField  TSTjia  JLau  DTGurwitz  JH Unexplained variation across US nursing homes in antipsychotic prescribing rates. Arch Intern Med 2010;170 (1) 89- 95
Holmes  HMHayley  DCAlexander  GCSachs  GA Reconsidering Medication appropriateness for patients late in life. Arch Intern Med 2006;166 (6) 605- 609